• 한국간호교육학회지
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• 제18권3호
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• pp.403-412
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• 2012

Purpose: This study compared the effects of three oral care methods on thirst and oral status in patients after general anesthesia surgery. Methods: Sixty five surgical patients were prospectively randomized into three groups. Each group received one of three oral care methods: wet water gauze, frozen water gauze, or frozen normal saline gauze. The outcomes of thirst and oral status were assessed three times by trained investigators blinded to the oral care methods. Assessment times were right after a participant's arrival to his/her room, and at 30 and 60 minutes after the pre-test. Results: The levels of thirst and oral status were significantly improved as time passed in all three oral care methods. While the level of thirst was not significantly different between the three groups, the level of oral status was significantly better with wet water gauze than frozen gauze groups, soaked in either water or normal saline. Conclusion: We recommend nurses choose one of three oral care methods based on patients' preferences since all three oral care methods showed similar effects in improving postoperative patients' levels of thirst and oral status.

• 중환자간호학회지
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• 제14권1호
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• pp.28-39
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• 2021

Purpose : This study investigated the occurrence of postoperative ileus and its related factors in patients after spinal surgery. Methods : After a retrospective review of data from patients who underwent spinal surgery at a single hospital located in Busan from 2012 through 2016, a total of 253 patients were included. The subjects were divided into non-ileus and ileus groups. We compared patient-, surgery-, and postoperative hematological-related factors. Results : A total of 41 (16.2%) out of 253 patients experienced postoperative ileus. Data analysis revealed significant differences between the two groups in mean age (68.44 vs 60.50 years), occupation (9.8 vs 28.8%), cardiovascular comorbidity (63.4 vs 37.7%), approach of surgery (supine/prone: 29.3/70.7 vs 12.7/87.3%), duration of anesthesia (5.86 vs 4.43 hours), narcotic use (75.6 vs 56.6%), postoperative serum hemoglobin level (3 days: 10.81 vs 11.41 g/dL), postoperative serum protein (immediately/3 days: 5.30/5.43 vs 5.62/5.68 g/dL), postoperative albumin level (3 days: 3.17 vs 3.40 g/dL), postoperative C-reactive protein level (3 days: 11.44 vs 8.36 mg/dL), postoperative bed stabilization period (3.32 vs 2.50 days), and onset of bowel movement (2.59 vs 1.94 days). In multivariate logistic regression, age and time of anesthesia were independent risk factors of postoperative ileus. Conclusion : To detect ileus after spinal surgery early, nurse education is needed with intensive screening on advanced age, surgery-related factors, and postoperative hematological indices.

• 근관절건강학회지
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• 제22권2호
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• pp.57-66
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• 2015

Purpose: The purpose of this study was to evaluate the incidence of postoperative delirium in elderly patients with osteoarthritis surgery and identify risk factors for its development. Methods: This study enrolled 288 patients who underwent osteoarthritis surgery in a hospital between May and November 2014. Data were collected prospectively. The Nursing Delirium Screening Scale was used to detect delirium. Multivariable logistic regression analysis was used to identify independent risk factors for postoperative delirium. Patients were also followed for outcome. Results: Postoperative delirium developed in 42 patients (14.6%). Logistic regression analysis identified old age, low physical activity, antipsychotic agents, number of catheters, and intensive care unit admission as risk factors. Worse outcomes, including increased hospital mortality, reoperation, and discharge at care facilities, occurred in subjects who developed delirium. Conclusion: Osteoarthritis surgery in elderly patients was associated with a high incidence of postoperative delirium. The results of the this study regarding patient populations vulnerable to delirium should be taken into account so that such patients could be identified preoperatively or in the immediate postoperative period.

• 대한장애인치과학회지
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• 제8권2호
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• pp.134-138
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• 2012

In treatment of dentigerous cyst, complete enucleation, histopathologic examination and postoperative care are important to prevent the potential complications (mural ameloblastoma, squamous cell carcinoma). On the other hand, a maxillary impacted supernumerary anterior tooth are removed surgically, owing to the possibility of the cyst formation in future. After the cyst enucleation and extraction of the involved tooth, the wound area sutured and removable resin plate is then applied. In this operation, the postoperative bleeding and infection is likely to occur owing to postoperative accumulation of hematoma & seroma, psychologic stress and other contaminated factor. So, the authors established the immediate rubber & iodoform gauze drainage into the sutured wound of cyst enucleation & tooth extraction for the prevention of postoperative bleeding and infection. The removable resin splint are not used because of the poor cooperation and economic factor. The results were more favorable without the postoperative bleeding & wound infection in a cerebral palsy patient.

• The Korean Journal of Pain
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• 제23권4호
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• pp.247-253
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• 2010

Background: Epidural anesthesia is widely used to provide pain relief, whether for surgical anesthesia, postoperative analgesia, treatment of chronic pain, or to facilitate painless childbirth. In many cases, however, the epidural catheter is inserted blindly and the indwelling catheter position is almost always uncertain. Methods: In this study, the loss-of-resistance technique was used and an imaging agent was injected through the indwelling epidural anesthesia catheter to confirm the position of its tip and examine the migration rate. Study subjects were patients scheduled to undergo surgery using general anesthesia combined with epidural anesthesia. Placement of the epidural catheter was confirmed postoperatively by injection of an imaging agent and X-ray imaging. Results: The indwelling epidural catheter was placed between upper thoracic vertebrae (n = 83; incorrect placement, n = 5), lower thoracic vertebrae (n = 123; incorrect placement, n = 5), and lower thoracic vertebra-lumbar vertebra (n = 46; incorrect placement, n = 7). In this study, a relatively high frequency of incorrectly placed epidural catheters using the loss-of-resistance technique was observed, and it was found that incorrect catheter placement resulted in inadequate analgesia during surgery. Conclusions: Although the loss-of-resistance technique is easy and convenient as a method for epidural catheter placement, it frequently results in inadequate placement of epidural catheters. Care should be taken when performing this procedure.

• 기본간호학회지
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• 제26권1호
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• pp.32-41
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• 2019

Purpose: The purpose of this study was to identify the risk factors for postoperative pulmonary complications (PPCs) after upper or lower abdominal digestive tract surgery. Methods: Participants in this retrospective observational study had undergone upper or lower digestive tract surgery and entered the surgical intensive care unit between March 1, 2016 and February 28, 2017. Data were collected from the medical records, operative records, results of laboratory test, and the nursing records of the hospitals. Results: Of the patients, 544 patients were enrolled in the study and PPCs -developed in 335 (61.6%) patients. On multivariate logistic regression analysis, significant risk factors of PPCs were identified: BMI (Body Mass Index; $kg/m^2$), preoperative serum BUN (Blood Urea Nitrogen; mg/dL), abdominal open surgery, or blood transfusion during operation. Conclusion: These risk factors could be used to help identify patients at risk for PPCs and then appropriate nursing interventions could be provided for patients at risk of PPCs.

• 기본간호학회지
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• 제21권4호
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• pp.423-432
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• 2014

Purpose: This study was done to evaluate effectiveness of deep breathing exercise as a postoperative intervention to prevent pulmonary complications. Methods: A search of databases from 1990 to 2012 was done including MEDLINE, EMBASE, CINAHL, Cochrane Library and eight Korean databases. Ten studies met eligibility criteria. Researchers trained in systematic review, independently assessed the methodological quality of selected studies using the Cochrane's risk of bias tool. Data were analyzed using RevMan 5.2 program. Results: Among ten RCTs in four studies, deep breathing exercise was compared with an instrument using interventions such as incentive spirometry, in the other four studies deep breathing exercise was compared with non-intervention, and in last two studies bundles of interventions including coughing and early ambulation were assessed. A significant difference was found between deep breathing exercise group and non-intervention group. The odds ratio (OR) of occurrence of pulmonary complications for deep breathing exercise versus non-intervention was 0.30. However, there was no significant difference between deep breathing exercise group and incentive spirometry group (OR=1.22). Conclusion: Deep breathing exercise is vital to improving cost-effectiveness and efficiency of patient care in preventing postoperative pulmonary complications. For evidence-based nursing, standardized guidelines for deep breathing in postoperative care should be further studied.

• 한국산학기술학회논문지
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• 제12권3호
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• pp.1260-1269
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• 2011

본 연구의 목적은 갑상선 유두암환자의 수술 후 삶의 질, 갑상선 특이적 증상, 자가간호이행도, 불안 및 우울수준을 파악하고 수술 후 삶의 질에 미치는 영향 요인을 분석하는 것이다. 154명의 갑상선 유두암환자가 연구에 참여하였으며 구조화된 질문지를 이용하여 수집된 자료는 SPSS/WIN 18.0을 사용하여 기술통계, t-test, ANOVA, Pearson correlation 및 다중회귀분석법으로 분석하였다. 갑상선 유두암환자의 수술 후 삶의 질 평균점수는 2.72점이었고 사회/가족상태 영역에서 가장 낮았으며 연구대상자들의 대부분은 피로, 추위를 견디지 못함, 변덕스런 기분변화 등의 갑상선 특이적 증상을 호소하였다. 자가간호이행 참여도가 가장 높은 항목은 갑상선호르몬제 복용(100%)이었으며 외래방문을 통한 추후관리는 두 번째로 높았다(99.4%). 불안은 45.3점으로 보통 수준이었으나 대상자의 63%가 우울한 상태로 판정되었다. 갑상선 유두암환자의 수술 후 삶의 질은 갑상선 특이적 증상, 불안, 우울과 부정적 상관관계가 유의하게 나타났으며(r=-.573, p<.001; r=-.739, p<.001; r=-.742, p<.001) 갑상선 특이적 증상, 불안, 우울이 수술후 삶의 질 정도를 64.9% 설명하였다. 이에 갑상선 유두암환자의 수술 후 삶의 질을 증진시키기 위해서 건강관리전문가들은 장기간의 암치료과정에서 느끼는 부정적 정서를 완화시키고 지지체계를 개발하며 신체적, 심리적 증상관리를 돕는 실무정보를 제공해야 할 것이다.

• Journal of Gastric Cancer
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• 제11권2호
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• pp.101-108
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• 2011

Purpose: Despite the compelling scientific and clinical data supporting the use of early oral nutrition after major gastrointestinal surgery, traditional bowel rest and intravenous nutrition for several postoperative days is still being used widely after gastric cancer surgery. Materials and Methods: A phase II study was carried out to evaluate the feasibility and safety of postoperative early oral intake (water intake on postoperative days (POD) 1-2, and soft diet on POD 3) after a gastrectomy. The primary outcome was morbidity within 30 postoperative days, which was targeted at <25% based on pilot study data. Results: The study subjects were 90 males and 42 females with a mean age 61.5 years. One hundred and four (79%) and 28 (21%) patients underwent a distal and total gastrectomy, respectively. The postoperative morbidity rate was within the targeted range (15.2%, 95% CI, 10.0~22.3%), and there was no hospital mortality. Of the 132 patients, 117 (89%) successfully completed a postoperative early oral intake regimen without deviation; deviation in 10 (8%) due to gastrointestinal symptoms and in five (4%) due to the management of postoperative complications. The mean times to water intake and a soft diet were $1.0{\pm}0.2$ and $3.2{\pm}0.7$ days, respectively, and the mean hospital stay was $10.0{\pm}6.1$ days. Conclusions: Postoperative early oral intake after a gastrectomy is feasible and safe, and can be adopted as a standard perioperative care after a gastrectomy. Nevertheless, further clinical trials will be needed to evaluate the benefits of early oral nutrition after upper gastrointestinal surgery.

• Journal of Chest Surgery
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• 제55권1호
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• pp.20-29
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• 2022

Background: Patients with high-risk (HR) operable non-small cell lung cancer (NSCLC) may have unique prognostic factors. This study aimed to evaluate surgical outcomes in HR patients and to investigate prognostic factors in HR patients versus standard-risk (SR) patients. Methods: In total, 471 consecutive patients who underwent curative lung resection for NSCLC between January 2012 and December 2017 were identified and reviewed retrospectively. Patients were classified into HR (n=77) and SR (n=394) groups according to the American College of Surgeons Oncology Group criteria (Z4099 trial). Postoperative complications were defined as those of grade 2 or higher by the Clavien-Dindo classification. Results: The HR group comprised more men and older patients, had poorer lung function, and had more comorbidities than the SR group. The patients in the HR group also experienced more postoperative complications (p≤0.001). More HR patients died without disease recurrence. The postoperative complication rate was the only significant prognostic factor in multivariable Cox regression analysis for HR patients but not SR patients. HR patients without postoperative complications had a survival rate similar to that of SR patients. Conclusion: The overall postoperative survival of HR patients with NSCLC was more strongly affected by postoperative complications than by any other prognostic factor. Care should be taken to minimize postoperative complications, especially in HR patients.